WEITZEL, THOMAS
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WEITZEL, THOMAS
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thomas.weitzel@gmail.com
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14007561700

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2024 2024 0.0 0.0 0.2 0.2 0.4 0.4 0.6 0.6 0.8 0.8 1.0 1.0

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Intestinal protozoa in returning travellers: a GeoSentinel analysis from 2007 to 2019

2024 , WEITZEL, THOMAS , Ashley Brown , Michael Libman , Cecilia Perret , Ralph Huits , Lin Chen , Daniel T Leung , Karin Leder , Bradley A Connor , Marta D Menéndez , Hilmir Asgeirsson , Eli Schwartz , Fernando Salvador , Denis Malvy , Mauro Saio , Francesca F Norman , Bhawana Amatya , Alexandre Duvignaud , Stephen Vaughan , Marielle Glynn , Carsten Schade Larsen , Christian Wejse , Martin P Grobusch , Abraham Goorhuis , Emmanuel Bottieau , Marc Shaw , Annemarie Hern , Watcharapong Piyaphanee , Wasin Matsee , Jose Muñoz , Israel Molina , Frank Mockenhaupt , Francesco Castelli , Alberto Matteelli , Christina Coyle , Paul Kelly , Cosmina Zeana , Simin Aysel Florescu , Corneliu Petru Popescu , Stephen Vaughan , Susan Kuhn , Susan Anderson , Kunjana Mavunda , Carmelo Licitra , Francois Chappuis , Gilles Eperon , Jesse Waggoner , Henry Wu , Sabine Jordan , Johnnie Yates , Phi Truong Hoang Phu , Prativa Pandey , Michael Beadsworth , Jose Perez-Molina , Philippe Gautret , Emilie Javelle , Noreen Hynes , Elizabeth Barnett , Dan Bourque , Ann Settgast , Christina Greenaway , Sapha Barkati , Cedric Yansouni , Arpita Chakravarti , Camilla Rothe , Mirjam Schunk , Federico Gobbi , Nancy Piper Jenks , Marina Rogova , John Cahill , Ben Wyler , Frank Patterson , Anne McCarthy , Eric Caumes , Oula Itani , Els van Nood , Hedvig Glans , Mugen Ujiie , Satoshi Kutsuna , Shaun Morris , Kescha Kazmi , Terri Sofarelli , Katherine Plewes , Yazdan Mirzanejad , Pierre Plourde , Jacquie Shackel , Yukihiro Yoshimura , Natsuo Tachikawa , Patricia Schlagenhauf , Annelies Zinkernage , Kristina M Angelo

Abstract Background Prolonged diarrhoea is common amongst returning travellers and is often caused by intestinal protozoa. However, the epidemiology of travel-associated illness caused by protozoal pathogens is not well described. Methods We analysed records of returning international travellers with illness caused by Giardia duodenalis, Cryptosporidium spp., Cyclospora cayetanensis or Cystoisospora belli, reported to the GeoSentinel Network during January 2007–December 2019. We excluded records of travellers migrating, with an unascertainable exposure country, or from GeoSentinel sites that were not located in high-income countries. Results There were 2517 cases, 82.3% giardiasis (n = 2072), 11.4% cryptosporidiosis (n = 287), 6.0% cyclosporiasis (n = 150) and 0.3% cystoisosporiasis (n = 8). Overall, most travellers were tourists (64.4%) on long trips (median durations: 18–30 days). Cryptosporidiosis more frequently affected people < 18 years (13.9%) and cyclosporiasis affected people ≥ 40 years (59.4%). Giardiasis was most frequently acquired in South Central Asia (45.8%) and sub-Saharan Africa (22.6%), cryptosporidiosis in sub-Saharan Africa (24.7%) and South-Central Asia (19.5%), cyclosporiasis in South East Asia (31.3%) and Central America (27.3%), and cystoisosporiasis in sub-Saharan Africa (62.5%). Cyclosporiasis cases were reported from countries of uncertain endemicity (e.g. Cambodia) or in countries with no previous evidence of this parasite (e.g. French Guiana). The time from symptom onset to presentation at a GeoSentinel site was the longest amongst travellers with giardiasis (median: 30 days). Over 14% of travellers with cryptosporidiosis were hospitalized. Conclusions This analysis provides new insights into the epidemiology and clinical significance of four intestinal protozoa that can cause morbidity in international travellers. These data might help optimize pretravel advice and post-travel management of patients with travel-associated prolonged gastrointestinal illnesses. This analysis reinforces the importance of international travel-related surveillance to identify sentinel cases and areas where protozoal infections might be undetected or underreported.

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